The Cognitive Function and Neurologic Status of Patients over 75 Years Depending on the Choice of Surgical Revascularization

Artem Stepin, Sergey Matveev, Dmitry Mamontov

Ural Cardiology Institute, Yekaterinburg, Russia

Date, time and location: 2018.05.26 08:30, Exhibition area, 1st Floor. Zone – C

Abstract

Objective: Objective: The aim of the retrospective study was to analyse the results of «unaortic total arterial revascularisation»  technique in patients older than 75 years in  comparison to conventional operations.

Material and methods: The retrospective analysis with followig end-points: postoperative morbidity and mortality, including neurologic complications I and II types, graft occlusion and reinterventions. 300 patients over 75 years (77,03+1,57 years in average) were operated  on in the period from 2010 to 2017.  211 patients (70,3%) have been operated on using full arterial revascularization off pump technique without any manipulations on the ascendens aorta (G1 group), the 89 patients (29,9%) have been operated on by the standard technique, including a cannulations of the ascending aorta and/or vein bypasses (G2 group). Both groups were comparable in terms of preoperative risk factors, including the Euroscore II score (G1 2,17+0,74 vs G2 2,3+1,03).

Results: Between the groups studied reliable distinctions by quantity of distal anastomosis have not been revealed (G1 = 2,4+1,3 vs G2 = 2,7+0,9). Mortality was 2,8% in G1 and 3,4% in G2. (p=0,97). The quantity of neurologic complications of I and II types was lower in G1 (0% vs 2,2%, p < 0,001; 12,8% vs 16,6%, p <0,01). There was observed the tendency to decrease in frequency of renal failure (33,6% vs 41,6%, p <0,01), duration of stay in intensive care unit (2,19+0,8 vs 3,08+1,2 p <0,05) and the general length of stay (13,27+0,87 vs 15,25 + 2,1 p <0,05) in G1. The angiographic research has shown potency of 98,4% of bypasses in G1 against 95% in the G2 (p <0,01).

Conclusions: The full arterial revascularization off pump technique without manipulations on the ascendens aorta is the safe and effective procedure in elderly patients in terms of neurologic complications and renal failure with comparable potency of grafts in the early postoperative period.